Page 11 - Parsons and Parsons Corp ODD EE Guide 1 1 17_FINAL 11.1.16

Benefits For Your Health

MEDICAL INSURANCE

Kaiser Kaiser Aetna
Hawaii Mid-Atlantic NJ / PA
Plan Name HMO HMO HMO
Eligible Employee Classes Parsons Corp Parsons Corp Parsons Corp
Network Name Kaiser HI Kaiser SIG
Health Benefits

Lifetime Maximum Unlimited Unlimited Unlimited
Deductible (Annual)
- Individual / Family $0 / $0 $0 / $0 $0 / $0
Co-Insurance (Plan Pays) 90% 100% 90%
Office Visit Copay
- Primary Care Physician $14 $30 $20
- Specialist Office Visit $14 $50 $20

Out-of-Pocket Maximum
- Individual / Family $1,500 / $4,500 $3,500 / $9,400 $2,000 / $4,000
Hospitalization
- Inpatient Covered 100% $500 per admit 90% after deductible
- Outpatient Covered 100% $50 90% after deductible

Lab and X-Ray 90% after deductible Covered 100% $0 Lab and $20 X-Ray
Emergency Services $25 $100 $100
Urgent Care $14 $50 $100

Preventive Care Covered 100% Covered 100% Covered 100%
Chiropractic Not covered Not covered Not covered
Pharmacy Benefits
Pharmacy Deductible
- Individual / Family $0 / $0 $0 / $0 $0 / $0
Retail Pharmacy
- (Generic/Brand/Non-Formulary) $10 / $10 / $75 $10 / $15 $10 / $30 / $45

Retail Preventive—ACA Preventive Eligible expenses Eligible expenses Eligible expenses
covered 100% covered 100% covered 100%
- Supply Limit 30 Days 30 Days 30 Days
Mail Order
- (Generic/Brand/Non-Formulary) $20 / $20 / $150 $20 / $30 $20 / $60 / $90

ACA Preventive Eligible expenses Eligible expenses Eligible expenses
covered 100% covered 100% covered 100%
- Supply Limit 90 Days 90 Days 90 Days

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